{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:49:01Z","timestamp":1787870941503,"version":"build-2784847793"},"reference-count":58,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Patients with repaired Tetralogy of Fallot (rToF) typically report having preserved subjective exercise tolerance. Chronic pulmonary regurgitation (PR) with varying degrees of right ventricular (RV) dilation as assessed by cardiac magnetic resonance imaging (MRI) is prevalent in rToF and may contribute to clinical compromise. Cardiopulmonary exercise testing (CPET) provides an objective assessment of functional capacity, and the International Physical Activity Questionnaire (IPAQ) can provide additional data on physical activity (PA) achieved. Our aim was to assess the association between CPET values, IPAQ measures, and MRI parameters. All rToF patients who had both an MRI and CPET performed within one year between March 2019 and June 2021 were selected. Clinical data were extracted from electronic records (including demographic, surgical history, New York Heart Association (NYHA) functional class, QRS duration, arrhythmia, MRI parameters, and CPET data). PA level, based on the IPAQ, was assessed at the time of CPET. Eighty-four patients (22.8 \u00b1 8.4 years) showed a reduction in exercise capacity (median peak VO2 30 mL\/kg\/min (range 25\u201333); median percent predicted peak VO2 68% (range 61\u201378)). Peak VO2, correlated with biventricular stroke volumes (RVSV: \u03b2 = 6.11 (95%CI, 2.38 to 9.85), p = 0.002; LVSV: \u03b2 = 15.69 (95% CI 10.16 to 21.21), p &lt; 0.0001) and LVEDVi (\u03b2 = 8.74 (95%CI, 0.66 to 16.83), p = 0.04) on multivariate analysis adjusted for age, gender, and PA level. Other parameters which correlated with stroke volumes included oxygen uptake efficiency slope (OUES) (RVSV: \u03b2 = 6.88 (95%CI, 1.93 to 11.84), p = 0.008; LVSV: \u03b2 = 17.86 (95% CI 10.31 to 25.42), p &lt; 0.0001) and peak O2 pulse (RVSV: \u03b2 = 0.03 (95%CI, 0.01 to 0.05), p = 0.007; LVSV: \u03b2 = 0.08 (95% CI 0.05 to 0.11), p &lt; 0.0001). On multivariate analysis adjusted for age and gender, PA level correlated significantly with peak VO2\/kg (\u03b2 = 0.02, 95% CI 0.003 to 0.04; p = 0.019). We observed a reduction in objective exercise tolerance in rToF patients. Biventricular stroke volumes and LVEDVi were associated with peak VO2 irrespective of RV size. OUES and peak O2 pulse were also associated with biventricular stroke volumes. While PA level was associated with peak VO2, the incremental value of this parameter should be the focus of future studies.<\/jats:p>","DOI":"10.3390\/jcdd9010026","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T10:57:37Z","timestamp":1642071457000},"page":"26","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Cardiopulmonary Exercise Testing in Repaired Tetralogy of Fallot: Multiparametric Overview and Correlation with Cardiac Magnetic Resonance and Physical Activity Level"],"prefix":"10.3390","volume":"9","author":[{"given":"Benedetta","family":"Leonardi","sequence":"first","affiliation":[{"name":"Department of Cardiology and Cardiac Surgery, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Gentili","sequence":"additional","affiliation":[{"name":"Department of Sport Medicine, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Alfonso","family":"Perrone","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiac Surgery, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"},{"name":"Department of Cardiology and University Sports Centre, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Sollazzo","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9967-1861","authenticated-orcid":false,"given":"Lucia","family":"Cocomello","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, University of Bristol, Bristol BS2 8HW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3228-3773","authenticated-orcid":false,"given":"Stefani","family":"Silva Kikina","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Wald","sequence":"additional","affiliation":[{"name":"Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelio","family":"Secinaro","sequence":"additional","affiliation":[{"name":"Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Giulia","family":"Gagliardi","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiac Surgery, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attilio","family":"Parisi","sequence":"additional","affiliation":[{"name":"Department of Movement, Human and Health Science, University of Rome Foro Italico, 00135 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attilio","family":"Turchetta","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiac Surgery, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Galletti","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiac Surgery, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0587-5899","authenticated-orcid":false,"given":"Massimiliano","family":"Bianco","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1888-373X","authenticated-orcid":false,"given":"Fabrizio","family":"Drago","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiac Surgery, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s12098-020-03274-3","article-title":"Approach to Cyanotic Congenital Heart Disease in Children","volume":"87","author":"Rohit","year":"2020","journal-title":"Indian J. 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